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The state of renal sympathetic denervation for the management of patients with hypertension: A systematic review and meta‐analysis
Author(s) -
Syed Moinuddin,
Osman Mohammed,
Alhamoud Hani,
Saleem Maryam,
Munir Muhamad Bilal,
Kheiri Babikir,
Balla Sudarshan,
Kawsara Akram,
Daggubati Ramesh
Publication year - 2021
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.29384
Subject(s) - medicine , blood pressure , ambulatory blood pressure , denervation , cochrane library , ambulatory , randomized controlled trial , meta analysis , diastole , cardiology , anesthesia
Background Sympathetic nervous system plays a central role in the development and persistence of essential hypertension. In recent years renal sympathetic denervation (RSD) has emerged as a promising option for the treatment of patients with hypertension. Methods We conducted a literature search of PubMed, EMBASE, Cochrane library and Clinicaltrials.gov from inception through April 20, 2020. Outcomes of interest were change in 24‐hour ambulatory systolic (ASBP) or diastolic blood pressure (ADBP) and change in office systolic (OSBP) or diastolic blood pressure (ODBP). We pooled data from randomized controlled trials (RCTS) comparing RSD to sham procedures in the management of hypertension using the random effect model. Results A total of 1,363 patients from eight studies were included in the current meta‐analysis. The mean age of the included patients was 56 ± 2.6 years, 29% were women and the median duration of maximum follow up was 6‐month (range 3–12 month). There was more reduction favoring RSD in ASBP (Weighted mean difference [WMD] ‐3.55; 95% CI ‐4.91 – −2.19, p < .001, I 2 = 0%), ADBP (WMD ‐1.87; 95% CI ‐3.07 – −0.66, p = .002, I 2 = 43%), OSBP (WMD ‐5.5; 95% CI ‐7.59 – −3.40, p < .001, I 2 = 7%) and ODBP (WMD ‐3.20; 95% CI ‐4.47 – −1.94, p < .001, I 2 = 14%). Conclusion The use of RSD for the management of hypertension resulted in effective reduction in the ambulatory and office blood pressure compared to sham procedure. Adequately powered RCTs of RSD are needed to confirm safety, reproducibility and assess the impact on clinical outcomes.